Endoscopic accessory

ABSTRACT

Devices and methods of use for an endoscopic accessory device that can be assembled and advanced over an endoscope positioned at a site within the body, the endoscopic accessory device including a body structure having seam structures on opposite sides of an elongate body structure, where the seam structures can be releasably joined to transform the body structure from a planar configuration to a tubular configuration.

FIELD OF INVENTION

The devices described herein relate an accessory device for improvingexamination of body organs, particularly a gastrointestinal tract.

BACKGROUND OF INVENTION

Endoscopy is a well-known procedure for examining the internal organs.The procedure is performed under the guidance of an endoscope. Currentlyused fiber optic endoscopes include lenses mounted in a flexible tubethat relay an image from inside a body cavity for viewing by a physicianfor diagnosis or manipulation inside the body cavity.

In performing an endoscopy, it is common to insufflate (introduce airinto) the gastrointestinal tract in order to provide easiervisualization. This can cause bloating and discomfort to the patient or,in rare cases, severe abdominal pain.

Since the gastrointestinal tract is a hollow organ, it is not possibleto keep the insufflation limited to part of gastrointestinal tract needsto be examined. To address, that we proposed a new accessory that canenclose a part of gastrointestinal tract around the tip of endoscope fordetail examination of a particular portion of the gastrointestinaltract. There is need, therefore, for an accessory tool for endoscopicexamination that creates an endoluminal compartment around the endoscopetip. Such endoluminal compartment can then be filled with air, water orcould be thoroughly lavaged using the device. Such a device can furtherinclude balloons comprising at least a proximal balloon for maintainingthe position of the endoscope accessory in an area to be examined and toseal the proximal end of the endoluminal compartment. There will be anindependently positioned distal balloon on a catheter for sealing thedistal end of the examination partition. The accessory device can alsoinclude a third balloon on the interior surface that creates a sealbetween the accessory device and endoscope to complete the endoluminalcompartment. The endoscope accessory can be advanced or retractedwithout the need to deflate and re-inflate the balloons, therebycreating a movable endoluminal compartment. The endoscope accessory canbe placed on an endoscope shaft without the necessity of having toremove the endoscope from the body. Some embodiments of the presentinvention provide such a device.

SUMMARY OF THE INVENTION

The present disclosure includes accessory devices for use with anendoscope or other medical device. Although variations of the device arediscussed as an endoscopic accessory device, the accessory device canaccommodate any number of diagnostic, therapeutic, and/or surgicaldevices. In one variation, the endoscopic accessory device comprises awall structure having a proximal portion spaced in a lengthwisedirection from a distal portion along an axis, the wall structure havinga first edge and a second edge extending parallel to the axis in thelengthwise direction from a proximal end of the proximal portion to adistal end of the distal portion and separated by a wall structurewidth, the wall structure including an interior surface, an exteriorsurface, and an intermediate space therebetween such that a fluid can bedelivered into the intermediate space to adjust a flexibility of thewall structure; a tip material located at to the distal portion andhaving a tip length extending distally beyond the distal end, the tipmaterial having a tip width greater than the wall structure width; afirst seam structure extending along the first edge and a second seamstructure extending along the second edge; a proximal balloon located onthe exterior surface at the distal portion; an inner balloon located onthe interior surface and proximally spaced from the distal end; aninstrument lumen extending from the proximal portion distally to theinner balloon and having an instrument lumen opening on the interiorsurface; and a hub portion at the proximal portion of the wall structureand on the exterior surface, the hub portion comprising at least aproximal balloon port fluidly coupled to the proximal balloon by anproximal balloon lumen, an inner balloon port fluidly coupled to theinner balloon by an inner balloon lumen, an instrument port fluidlycoupled to the instrument lumen, wherein in a pre-deploymentconfiguration the proximal balloon and the inner balloon are uninflated,and the wall structure is sufficiently flexible to assume a flat profileacross the wall structure width; wherein the first seam structure can bereleasably joined to the second seam structure to form a fluid tightseal therebetween such that the wall structure can form a closedovertube profile about the endoscope; wherein in the closed overtubeprofile the tip width of the tip material permits the tip material tocircumferentially overlap distal end.

Variations of the endoscopic accessory device include a flange portionon an interior surface and extending over the first seam structure suchthat in the closed overtube profile the flange portion covers the firstseam structure when joined to the second seam structure.

In an additional variation, a width of the inner balloon is greater thanthe wall structure width such that the inner balloon circumferentiallyoverlaps the fluid tight seal on the interior surface over the endoscopewhen in the closed overtube profile.

The endoscopic accessory devices can include a configuration where theinterior surface comprises an interior sheet of material and theexterior surface comprises an exterior sheet of material.

The devices disclosed herein can include any number of ports or openingson the interior or exterior of the device. For example, the device caninclude a catheter lumen extending from the proximal portion to thedistal portion and having a catheter opening on the interior surfacedistal to the inner balloon.

In an additional variation, the endoscopic accessory device furtherincludes a balloon catheter having a distal balloon and slidablymoveable through the catheter lumen, where the hub portion includes acatheter port fluidly coupled to the catheter lumen and a proximal endof the balloon catheter is slidably positioned in the catheter port. Adistal balloon located on the balloon catheter moving freely inside thecatheter lumen and while uninflated, can be stored in catheter lumen andcan be extended distal to the tip of endoscope and while inflatedcreates a seal at the distal end of endoluminal compartment. Variationsof the devices can include configurations where a flexibility of thedistal portion is greater than a flexibility of the proximal portion.Moreover, a flexibility of the tip material is different than theflexibility of the distal portion.

The endoscopic accessory devices can include any number of adhesiveregions on the tip material, such that the at least one adhesive regionpermits securing a first portion of the tip material to a second portionof the tip material in a conical or tubular shape.

The endoscopic accessory devices described herein can include alubrication lumen extending from the proximal portion proximally to theinner balloon and having multiple opening inside the interior surface ofthe wall structure and a lubrication port on the proximal hub fluidlycoupled to the lubrication lumen.

Variations of the device include, when in the closed overtube profile, aportion of the tip material overlapping the distal end of the exteriorsheet of the device and a portion of the first seam structure and thesecond seam structure.

The tip material of the accessory device can form a cylindrical shape ora conical shape at an end of the closed overtube profile.

The proximal balloon can expand to be asymmetrical about the wallstructure.

The endoscopic accessory devices described herein can include any numberof fluid ports and/or vacuum ports on the exterior surface of the wallstructure.

As the accessory device is made from two or more layers of sheets, thetwo sheets can be bound by ultrasonic bonding, sewing or RF weldingalong its entire length, at the longitudinal edges or other spots, andover a zipper edge that acts as longitudinal seam and closes theaccessory device longitudinally and turn the double layer sheets into anovertube profile. There are also multiple interspersed tacks bondingover the surface of the two sheets to hold the sheets together. Thezipper is located at the edge between the two layers. As such, the twolayers can accommodate the edge of the zipper that creates thelongitudinal seam between the two sheets. Moreover, the zipper iswaterproof.

The flexible bilayer structure of the accessory device allows the easeof compressibility of the accessory device and reshaping of the circularaccessory device into a shape that can easily accommodate the passage ofaccessory device over the endoscope within the gastrointestinal tractbends.

The bilayer or multilayer structure of the accessory device allows thepassage of the inflation and other tubes between the layers of thesheets along the accessory device to avoid exposure and friction ofthese tubes with body and or endoscope. The tubes that carry theproximal balloon or endoscope accessories can exit the space between thetwo sheets at the distal end portion of the accessory device and enterthe inside the endoluminal compartment.

The bilayer or multilayer structure of the accessory device allows aninflation or deflation between the layers of the sheets along theaccessory device to change the flexibility or rigidity of the accessorydevice.

The zipper alignment cutout aid can be at the distal end of theaccessory device. The zipper alignment cutout aid can be covered at thedistal end of the accessory device by the soft tip sheet.

Alternatively, the seam can be created by other interlocking mechanismssuch as self-fusing silicon tape, tongue and groove, complementaryedges, hook and loop, zip-lock-type fastener, adhesive straps and strapsand the like or a combination of these mechanisms.

The proximal end of the accessory device is supplied with an elastomericsealing bead or soft sealing material that when the accessory deviceforms, it turns into a proximal seal between the accessory device andendoscope.

The accessory device can further include more than one elastomericsealing bead on the internal surface of the accessory device forcreation a seal around the endoscope shaft within the accessory device.This elastomeric sealing bead on the internal surface of the flexibleaccessory device can be made from foam or other elastomeric materialthat does not allow free passage of air or fluid. The elastomericsealing bead has a rectangular surface when the accessory device is notformed. The proximal edge of the elastomeric sealing bead can have aramp that allows ease of passage of endoscope that enters the proximalend of the elastomeric sealing bead when the accessory device is formed.The elastomeric sealing bead can have a same height across thetransverse span of the accessory device so when the accessory device isformed the edges of the elastomeric sealing bead touch each other at thelevel of seam when the longitudinal edges are approximated.Alternatively, the elastomeric sealing bead can have a ramp toward thelongitudinal edges. This gradual decrease in height of the elastomericsealing bead allows the elastomeric sealing bead to take an eccentricshape when the accessory device is formed. This allows a better sealcreated by the elastomeric sealing bead over endoscope. The elastomericsealing bead seals the distal end of the accessory device around theendoscope so prevent the leakage of fluid and gas from the distal end ofthe accessory device into the lumen of the accessory device.Alternatively, the elastomeric sealing bead can be positioned on theinternal surface of the accessory device at the mid portion, or proximalend portion of the accessory device. Alternatively, there could be morethan one elastomeric sealing bead within the internal surface of theaccessory device.

Alternatively, the inner balloon can be positioned on the internalsurface of the accessory device at the mid portion, or proximal endportion of the accessory device. Alternatively, there could be more thanone inner balloon and one or more elastomeric sealing bead all installedwithin the internal surface of the accessory device.

The endoscope accessory can also include at least oneirrigation/drainage port. The irrigation/drainage port can be situatedon the accessory device hub and can include a closeable lid. Theirrigation/drainage port can allow a direct access to the lumen of theaccessory device. The irrigation/drainage port can be connected toirrigation/drainage tubes that can deliver water into or drain water outof the examination compartment in the gastrointestinal tract through thelumen of the accessory device.

The accessory device can further include at least one fluid/insufflationconduit that defines a passageway for inflating or suctioning fluid orair within the endoluminal compartment within the body cavity at thedistal end of the accessory device.

The accessory device can further include more than one instrument lumenthat defines a passageway for passing accessory tools from the proximalend of the accessory device into the endoluminal compartment within thebody cavity at the distal end of the accessory device.

The accessory device can further include at least one quick connectfitting. The quick connect fitting allows a detachable coupling ofmultiple tubes at the proximal end portion of the accessory device intoan umbilical extension tube. The umbilical extension tube has one quickconnect fitting on each end and serves as an extension tubing to connectthe accessory device to inflation, irrigation, insufflation or suctiondevices. The male-female interface of the quick connect fitting allows adetachable connection of multiple ports and tubes with one lockingaction. Example of the ports and tubes that can be detachably attachedthrough the quick connect fitting can include but not limited toinflation tube for positioning ring, inflation tube for sealing band/s,inflation tube for distal balloon, insufflation port for insufflationwith gas, irrigation tube for flushing port, suction conduits andfluid/insufflation conduit.

The accessory device can further be supplied with an automated controlsystem for automated control of inflation, insufflation, irrigating andsuctioning through the over tube. The automated control system cancontrol the inflation of the proximal balloon, inner balloon, distalballoon, insufflation of the compartment, injection or irrigating fluidinto the irrigation drainage port, irrigation conduit of flushing portand suctioning of the suction conduits. The automated control system caninflate and maintain each individual balloon pressure at an assigned setpoint, insufflate and maintain the endoluminal compartment pressure atan assigned set point, inject fluid into the assigned port and applysuction pressure to an assigned conduit. The activation and set pointsof the functions are adjusted through knobs or digital displays.

In use, the endoscope accessory of the claimed invention is a flexible,elongated sheet or sheets that envelops an endoscope shaft while theendoscope shaft is still within the body cavity without the need toremove the endoscope or pre-position the accessory device over theendoscope shaft prior to the endoscope insertion within the body cavity.However, as those skilled in the arts can understand, the device couldalso be placed prior to endoscope insertion.

After enveloping or surrounding the endoscope shaft by the sheet orsheets, the opposing longitudinal edge portions can be joined to form anaccessory device by creating a longitudinal seam along a portion or theentire length of the accessory device.

The accessory device seam joins together starting at the tip portionresulting in a closed distal end portion of the accessory device. Thetip portion can then be secured with at least one adhesive region overthe distal end portion of the wall structure and joined seam. Theaccessory device seam can extend further along the accessory device'slength or along a partial length. When an endoscope shaft is envelopedwithin the accessory device, the hub of the accessory device can begrasped and the distal portion of the accessory device pushed into thebody cavity of a patient with the guide of the endoscope shaft placed atthe desired location. The accessory device can advance just proximal tothe tip of the endoscope. In some variations of the accessory device,the device seam is closed starting from the distal end to a portion ofthe device to form a closed overtube shape. The closed overtube shapecan be inserted inside the colon while the seam of the more proximalpart of the accessory device remains open outside of the body cavity.

The inflatable proximal balloon is inflated to secure the position ofthe accessory device distal end portion within the body cavity andcreate a seal between the accessory device and body cavity, proximally.

The balloon catheter is pushed through the catheter lumen and after thedistal balloon exits the catheter lumen at the distal tip of theaccessory device, it is placed at the desired location, distal to thedistal tip of the endoscope. Then, the distal balloon is inflated. Thissecures the position of the distal balloon within the body cavity andalso seals the distal portion of the endoluminal compartment.

Then the inner balloon is inflated that can create a seal around theendoscope shaft within the accessory device. The endoscope can be movedindependent of the accessory device while the sealing is maintained. Theendoscope can be replaced if desired, with another endoscope while theaccessory device stays in its position within the body cavity.

The endoluminal compartment can be filled with any fluids, including butnot limited to air, CO2, or water and the pressure of the compartmentcan be controlled using manual valve, pressure relief valve andautomatically controlled pressure system, depending on applications. Inaddition, the endoluminal compartment can be thoroughly lavaged usingthe irrigation tubes connected to irrigation/drainage port or theproximal accessory device opening.

The endoluminal compartment can be made smaller or larger by changingthe position of the distal balloon by pushing or pulling the accessorydevice while maintaining the inflated proximal balloon without need fordeflation.

The endoluminal compartment can be moved along the body cavity, bypushing or pulling the entire accessory device without need fordeflation of the distal balloon, proximal balloon or inner balloon.

When the endoluminal compartment is moved along the body cavity, itmaintains its pressure and its content of air or water based on theapplication. This allows the endoscope to examine an extended part ofthe gastrointestinal tract as the location of the endoluminalcompartment glides over the intestinal lumen. At the preference of theuser the movement can be stopped or reversed.

When the compartment is moved along the body cavity, since the balloonsare passing part of gastrointestinal tract with different diameter andtone, the pressure in the balloons needs to be monitored and adjusted tomake sure the size of balloons properly fit the size of thegastrointestinal tract lumen. This is performed with monitoring of theballoon pressures.

When the compartment is moved along the body cavity while the balloonsare inflated, the movement of the inflated balloons along thegastrointestinal lumen creates a squeegee action and wipes fluidsecretion and residuals away the intestinal wall. This allows physicalcleaning and wiping of the intestinal lumen before examination by theendoscope. This is particularly important when the inflated proximalballoon wipes the intestinal wall off of fluid and residuals when theaccessory device is pulled out of the body cavity.

When the compartment is moved along the body cavity while the balloonsare inflated, the squeegee action of the balloons wipes the intestinalwall off of fluid secretion and residuals away from the movingcompartment. During this movement, the flushing port situated on theexternal surface of the accessory device between the inflatable proximalballoon and the proximal end portion of the accessory device are used toinject fluid to flush the body cavity proximal to the proximal balloon.This enhances the cleaning squeegee action of the proximal balloon.

The examination compartment can be used as a sealed compartment forpossible surgeries or access to spaces outside of gastrointestinaltract. In that case, after inflating the proximal and distal balloon,the endoscope can be removed and other surgical device/s is/are placedwithin the endoluminal compartment. The surgical devices can be used forexamination of peritoneum or perform intraperitoneal surgeries.

The proximal, distal and inner balloons can be deflated and inflatedindependent of each other or together as determined by the user.

After termination of the examination, all balloons are deflated and theovertube is removed independent of, or together with, the endoscope.

The present disclosure also includes methods of preparing a colon forexamination. In one example, the method includes advancing an endoscopicwithin the colon; advancing an endoscopic accessory device over theendoscope, the endoscopic accessory device including a first balloonadjacent to a distal opening; expanding the first balloon against a wallof the colon; positioning a balloon catheter through the distal openingsuch that a second balloon on the balloon catheter is spaced from thedistal opening; delivering a fluid through the endoscopic accessory tothe colon; expanding the second balloon against the wall of the colon;and withdrawing the first balloon and the second balloon while engagedagainst the wall of the colon to prepare the colon for examination.

Another variation of the method can include advancing an endoscopicwithin the colon; advancing an endoscopic accessory device over theendoscope, the endoscopic accessory device including a first balloonadjacent to a distal opening; expanding the first balloon against a wallof the colon; positioning a balloon catheter through the distal openingsuch that a second balloon on the balloon catheter is spaced from thedistal opening; delivering a fluid through the endoscopic accessory tothe colon by positioning a fluid reservoir at above the endoscopicaccessory such that gravity causes the fluid to flow into the colon;draining the fluid from the colon by lowering the fluid reservoir belowthe endoscopic accessory such that gravity causes a portion of the fluidto drain into the fluid reservoir; and expanding the second balloonagainst the wall of the colon and withdrawing the second balloon towardsthe distal end to cause the fluid to enter the distal opening and toprepare the colon for examination.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a variation of an endoscopic accessory device beingadvanced within a body cavity.

FIG. 2A illustrates the endoscopic accessory device of FIG. 1 prior tojoining of the seam structures for forming the tubular body structure.

FIG. 2B illustrates a top view of a distal portion of the device of FIG.2A.

FIG. 2C illustrates a top view of another variation of a distal portionof an endoscopic accessory device.

FIG. 2D illustrates a partial view of when the first seam structure isfastened to a second seam structure with alignment features for aligningthe seam structures.

FIGS. 3A and 3B show respective front and rear views of a variation ofan endoscopic accessory device similar to that shown in FIG. 2A.

FIG. 3C depicts a variation of the sealing structures when joinedtogether.

FIGS. 3D and 3E illustrate a cross sectional view of the wall structure226 of the accessory device.

FIGS. 4A and 4B illustrate respective side and top views of anothervariation of a hub without the wall structure, connectors or adaptors.

FIGS. 5A and 5B illustrates an endoscopic accessory device joined into atubular structure but prior to securing the tip about an endoscope.

FIG. 5C shows a state where an end of the tip material is insertedthrough the opening and prior to being secured to the remainder of thetip material.

FIGS. 6A and 6B illustrate a variation of an endoscopic accessory devicewhen positioned within a colon where the device can clean or prepare thecolon for examination.

FIGS. 7A to 7G illustrate another variation of an endoscopic accessorydevice for performing a right colonic enema with a variation of anendoscopic accessory device.

DETAILED DESCRIPTION OF THE INVENTION

Before explaining some aspects of embodiment of the present invention indetail, it is to be understood that the present invention is not limitedin its application to the details of arrangements of the components setforth in the following description. As can be appreciated by thoseskilled in the arts, the present invention is capable of otherembodiments and of being practiced and carried out in various ways.Also, it is to be understood that the phraseology and terminologyemployed herein are for the purpose of description and should not beregarded as limiting. It is also to be understood that where ranges areprovided for various aspects of the invention and for examples, they areapproximate ranges and are not to be limiting except where notedotherwise.

FIG. 1 illustrates a variation of an endoscopic accessory device 220advanced within a body passage 2 (e.g., a colon, gastro-intestinaltract, or other body passage), where the device 220 includes a distalballoon 222 and proximal balloon 236 as discussed above. While theillustrated variation is shown with an endoscope 90, but any medicaldevice can be used within the endoscopic accessory device 220. Examplesof inserted devices include examination device (such as scopes), as wellas treatment or therapy devices.

For purposes of illustration, the proximal balloon 236 is in an inflatedconfiguration state while the distal balloon 222 is inflated to expandfrom a balloon catheter 224. The location of the proximal balloon 236 isintended for illustration only and variations include one or moreproximal balloons 236 spaced farther away from the distal tip 238.

The proximal balloon 236 can be used for positioning of the device 220within the body. Alternatively, or in combination, the proximal balloon220 can be used to clear the organ as further discussed below.Variations of the device 220 include an examination compartment formedbetween the distal balloon 222 and proximal balloon 236. Thisexamination compartment can be moved along the body cavity 2 when theaccessory device 220, shaft 91 and the distal balloon 222 are all movedas a single unit in relation to the body. This movement can occurwithout deflating the distal balloon 222 or proximal balloon 236.Alternatively, either or both of the balloons 222 236 can be deflated,repositioned, and re-inflated as needed to establish an examinationcompartment at a desired location or to irrigate/clean the body passage2.

In the illustration shown in FIG. 1 , the endoscopic accessory device220 includes a body structure 226 comprising a wall structure asdiscussed below. In the example shown in FIG. 1 , the body structure 226is in a tubular shape where a first seam 228 joins with a second seam230, where the seams are located on the ends of the body structure 226.The exterior surface of the device 220 can include any number offeatures that assist the caregiver in advancing the device 220. Forexample, the variation shown in FIG. 1 includes distance markings 218that can be used to monitor advancement of the device 220 within thebody passage 2 or relative to the endoscope shaft 91. The device 220 canhave a length that is greater than, less than, or equal to the inserteddevice. However, devices 220 varying lengths are within the scope ofthis disclosure. As shown, the device 220 can be opened along an entireseam of the device 220 such that it can be placed over a medical withoutremoval of the medical device. Alternatively, the accessory device maybe used while the seam is only closed at the distal portion and theremains open at the proximal portion to accommodate smaller endoscopeswhile the accessory remains fully functional.

In variations of the device 220, the body structure 226 includes anouter surface 234 with a distal portion 244 and a proximal portion 246,each having different properties or characteristics. For example, thedistal portion 244 can have a greater flexibility than the proximalportion 246. This increased flexibility improves the ability of acaregiver to navigate the tubular body 226 through tight bends and turnswithin the anatomy. Similarly, the proximal portion 246 can be lessflexible or stiffer, which increases pushability the tubular body 226from a working end, handle, or any part of the device that is outside ofthe patient. It is noted that the distal portion 244 and proximalportion 246 can be constructed from various layers of materials suchthat the distal portion 244 and the proximal portion 246 comprise thesame material on an outside surface 234 of the device 220. In such avariation, the interior surface or the region within a wall structure ofthe distal portion 244 can comprise materials and/or structural featuresthat cause the distal portion 244 to be more flexible than the proximalportion 236.

The tubular body 226 also includes a distal tip 238 that encloses aroundan endoscope shaft 91 while allowing the endoscopic accessory device 220to slide relative to the endoscopic shaft 91. In variations of thedevice, the distal tip 238 can include a length that is sufficient foran end 240 of the tip 238 to wrap around the tubular body 226. Asdiscussed herein, the shaft 226 of the endoscopic accessory device 220includes a first seam structure 228 and a second seam structure 230 thatjoin together to allow the device 220 to form the tubular structure 226from a planar configuration. Variations can include any number of fluiddelivery or suction ports on an exterior of the device 220. FIG. 1 alsoillustrates an optional zipper mechanism 170 that can be used to closethe seam structures 228 230 together starting at a distal end of thedevice 220.

FIG. 2A illustrates the endoscopic accessory device 220 of FIG. 1 priorto joining of the seam structures 228 230 for forming the tubular bodystructure 226. The first seam structure 228 extends along an edge of thewall of the body structure 226 and the second seam structure 230 extendsalong the opposite edge of the wall of the body structure 226. As shown,the body structure 226 can assume a flat configuration where an innersurface 232 includes a distal region 247 and a proximal region 246having different flexible properties as noted above. In additionalvariations, the inner surface 232 can comprise a singlematerial/property where the varying degrees of stiffness are controlledby selection of the outer surface 234 (as shown in FIG. 1 ). Asdiscussed below, the body structure 226 wall can be formed by separatelayers (e.g., the outer surface 234 and inner surface 232 each comprisesa different layer). Alternatively, the body structure 226 wall cancomprise a single material having passages/lumens formed within thewall.

FIG. 2A also shows an interior flap 248 extending along the sealingstructure 230. This flap 248 can comprise an extension of the innerlayer 232 or can be a separate section of material sealingly joined tothe inner layer 232. As noted below, the flap 232 overlaps the joinedsealing structures 228 230 when the body structure 226 is in a tubularconfiguration. The combination of the sealing structure 228 230 andadhesive regions 242 allows for the body structure 226 to be fluidlysealed along the joined edges 228 230. The figures show the adhesiveregions 242 with tab 243 that allows removal of a cover from theadhesive regions 242.

FIG. 2A further shows the interior surface 232 to include a plurality oflubrication openings 254. These lubrication openings 254 allow for amedical caregiver to deliver water or lubrication fluid to the interiorof the body structure 226 when formed into a tubular shape, which allowsfor the endoscopic accessory device 220 to slide over a body of anendoscope. In an additional variation, the inner surface 232 of theaccessory device 220 can comprise a lubricious material or a materialwith a hydrophilic coating. In such a case, the ports 254 deliver afluid (e.g., water or saline) to activate the hydrophilic coating, whichreduces friction between the inner surface 232 and any medical deviceadvanced through the accessory device 220 with or without the use ofadditional lubrication. The wall structure 226 can be configured suchthat a fluid can be delivered between the interior surface and exteriorsurface (i.e., between the layers) to adjust a flexibility or rigidityof the wall structure when flat or when in an overtube shape.

The distal portion of the body structure 226 also includes an innerballoon 250 in an uninflated configuration as well as an proximalballoon (not shown) on the opposite side of the device 220 in anun-inflated configuration. As discussed herein, the body structure 226can incorporate any number of passages or lumens to fluidly couple theballoons 236 250, openings 254, suction channels, irrigation channels,or working channels 252 (e.g., for a balloon catheter) with ports orother fittings 262, 264 on a hub 260 on a proximal end of the device220. In one variation, one or more of the passages are formed fromtubular structures located within the body structure 226. These tubularstructures can provide further column strength when advancing the device220 over an endoscope.

In some variations of the device, the hub 260 can function as a handlefor manipulating the device. Alternatively, the main function of the hub260 can serve as a location for ports and or connectors 262, 264. Suchconnectors and ports can include coupling for external inflation tubes,quick connect fittings, distal balloon quick connect fittings, andirrigation/drainage ports, as well as delivery of various medical toolsthrough the device 220.

FIG. 2A also shows an example of a distal tip 238 that can enclose aboutan endoscope when in use. The distal tip 238 can comprise a flexiblematerial such that the flexibility of the tip 238 is greater than theflexibility of the adjacent interior wall section 232/244. As shown inFIG. 2A and discussed below, the distal tip comprises a width (i.e., asmeasured perpendicular to a length of the device 220) that exceeds awidth of the body structure 226 and sealing structures 228 230. Thisallows the tip 238 to form a cylindrical or conical shape at the end ofthe device 220 when formed into a tubular structure. In one variation,the belt 240 is inserted into an opening/slot/slit 239 in the tip 238.Variations of the device 220 include an opening slit 239 that ispositioned relative to a shoulder 245 of the tip 238 such that whenformed into a cylindrical/conical shape the shoulder 245 acts as a stopsurface, which limits the diameter of the enclosed tip 238 to preventover-tightening of the tip 238 onto an endoscope. Accordingly, theopening slit 239 and shoulder 245 can be spaced to accommodate astandard size endoscope or can have multiple openings to accommodateendoscopes of various sizes. In addition, the tip 238 can include anynumber of adhesive regions 242 with an adhesive removeable covers. Forexample, in the variation shown in FIG. 2A, the ends of the tip 238include adhesive regions 242 (e.g., a removable cover) that exposes theadhesive regions 242) to secure both ends of the tip 238 when formedinto a cylindrical or conical shape. In the illustrated drawing, theadhesive region 242 adjacent to the opening slit 239 includes a tabsection 243 that is unattached to the tip 238 and the adhesive region242, which allows a user to expose the adhesive region 242 to adhere toa portion of the tip. Likewise, the belt 240 of the tip includes anadhesive region with a tab 243 that allows removal of a cover.

FIG. 2A illustrates the endoscopic accessory device 220 having a barrier266 located at a proximal portion of the body structure 226. The barrier266 can extend across the width of the body structure 226 and optionallyover the flap 248. The barrier 266 can comprise a non-porous foam thatcreates a barrier to fluids that would otherwise leak out of theproximal end of the device 220. Alternatively, the barrier 266 cancomprise an absorbent foam material or other elastomeric material.

FIGS. 2B and 2C illustrate top views of distal portions of variations ofendoscopic accessory devices 220 similar to that shown in FIG. 2A. BothFigures illustrate a plurality of lumens or tubes 268, 270, 272, 274that are in fluid communication with various components of the device220. As noted above, variations of the device 220 can include a solidsection of material with lumens manufactured into the material.Alternatively, the wall structure 226 can include an outer layer (notshown in FIGS. 2B and 2C) and an inner layer 232 having a plurality oftubes or structures 268, 270, 272, 274 extending between the layers. Inthe variations shown, tube 268 terminates at an opening 252 for thedistal balloon catheter shown in FIG. 1 , tube 270 provides fluid forinflation of the inner balloon 250, tube 274 delivers lubrication fluidto lubrication ports 254, tube 272 is coupled to instrument opening 256for passage of endoscopic instrument tools. The proximal balloon andassociated tube are not shown in FIGS. 2B and 2C. Clearly, anyadditional number of tubes and/or openings or balloons are within thescope of this disclosure.

FIG. 2B further illustrates how placement of an opening slit 239 on atip 238 can be positioned relative to a shoulder 245 of the tip 238 tocontrol a opening diameter of the tip 238 such that the tip 238 is notlarge or over-tightened on an endoscope. As shown, the opening 239 isspaced from the shoulder 245 by a distance 276 along an edge of the tip238. This distance corresponds to the circumference of the tip 238 thatwill prevent the tip opening being too large or over-tightening on anendoscope. FIG. 2C illustrates a variation with multiple openings 239 toallow the device 220 to work with endoscopes of different diameters. Itis also noted that the openings 239 and shoulder 245 are positioned atan angle to a longitudinal axis of the body structure 226, this allowsfor the tip 238 to form a conical shape (as shown in FIG. 1 ). Theconical shape allows for advancement of the device 226 through the bodypassage as opposed to an abrupt transition given the difference in sizesbetween the endoscope and wall structure 226 when formed into a tubularshape.

FIG. 2C also illustrate an additional variation of a device 220 wherethe first seam structure 228 and second seam structure 230 haverespective alignment surface features 258 259 on a distal end. In theillustrated variation, alignment feature 258 is a stepped cutout, whilealignment feature 259 is a stepped shoulder. When the seam structures228 and 230 are joined together, the alignment features 258 259 nesttogether to ensure that the ends of the seam structures 228 and 230 arenot mis-aligned or offset when joined together. Moreover, the alignmentfeatures 258 259 can simply make it easier/quicker for a caregiver toform the body structure 226 into a tube shape over an endoscope/medicaldevice.

FIG. 2D illustrates a partial view of when the first seam structure 228is fastened to a second seam structure (not visible in FIG. 2D becauseit is below the first seam structure 228). As shown, the alignmentfeature 258 of the first seam structure 228 nests with the alignmentfeature 259 of the second seam structure. FIG. 2D also illustrates aproximal end 235 of the tip 238 covering an end of the seam structure228. As noted herein, variations of the device 220 provide for the tip238 to wrap over the seam structure 228, to reduce the chance that theabrupt edge of the seam structure 228 encounters resistance whenadvanced in a body passageway. It also shows the proximal edge 235 ofthe tip 238 covering the distal end of the outside surface 234.

FIGS. 3A and 3B show respective front and rear views of a variation ofan endoscopic accessory device 220 similar to that shown in FIG. 2A Forpurposes of illustration the proximal balloon (236 in FIG. 2A) isdeflated. FIG. 3A shows the hub 260 of the device 220 having a number ofports and connectors (e.g., 262, 263, 264, 265) that allow access to thevarious lumens, openings, and balloons of the device 220. The ports andconnectors can comprise standard luer fittings and tuohy borst adapterscommonly used in medical applications. In addition, one or more of theconnectors 262, 264 can include flush ports 263 that allow a user of thedevice 220 to deliver lubrication or other fluid while advancing adevice through a port 262, 264. FIG. 3A also illustrates the adhesiveregion 241 and adhesive removeable cover 242 having a flap or tab 243that allows removal of the adhesive removeable cover 242 to expose anadhesive regions 241 that secures the tip 238 into a conical or tubularform. While not shown in FIG. 3A, the belt 240 of the tip 238 can alsooptionally include an adhesive region.

FIGS. 3A and 3B also show a variation of a first seam structure 228 anda second seam structure 230. As shown, the seam structures can includeany structure that allows for removably locking the seam structures 228,230 together. FIG. 3C illustrates a partial view of seam structures 228230 joined together to allow wall structure 226 to form a tubular shapewhere the inner surface 232 is interior to the tube shape and the outersurface 234 on an exterior of the tube. FIG. 3C also depicts a variationof the sealing structures 228 230 as joining together in directions 278,which is normal/radial direction relative to the tubular shape of thebody structure 226. Since the body structure 226 is flexible, a user canapply force directly on the first seam structure 228 and through thewall structure 226 on the second seam structure 230. FIG. 3C also showsthe interior flap 248 covers the seam structure 230 on an interior ofthe structure 226. The combination of the flap 248 and the seamstructures 228 and 230 increase the ability of the device 220 to have afluid tight seam.

FIG. 3A also shows a variation of the inner balloon 250 extending alongthe interior surface of the wall structure. As shown, the inner balloon250 can include an end portion 251 that can extend over the flap 248 orbeyond the flap 248. In the illustrated variation, the internal balloon250 extends over the second seam 230 with two ends 251 and 253, but theend 251 can extend beyond the seam 230 and cover the first seam 228 andtouch the end 253 of the balloon 250 or overlap the end 253 of theballoon 250. As noted, the end portion 251 of the internal balloon 250is shown as being unattached to the inner flap 248. Alternate variationsinclude the end portion 251 balloon being attached to the flap 248. Inadditional variations, the inner balloon 250 can include a width equalto the wall of the body portion 226 (e.g., between the seam structures228 230).

FIGS. 3D and 3E illustrate a cross sectional view of the wall structure226 of the accessory device. As shown, seam structures 228 230 can bejoined together and covered by an interior flap 248 to cause wallstructure 226 to form an overtube shape with an internal passage 273that can accommodate an endoscope 90 or other device. The illustratedratio of the wall structure 226 to the endoscope 90 is for illustrativepurposes only. The wall structure 226 can be made larger or smaller toprovide a closer fit with the endoscope 90.

In the variations shown in FIGS. 3D and 3E, the wall structure comprisesan inner layer 232 and an outer layer 23 with an intermediate space 233between layers 232, 234. The intermediate space can accommodate anynumber of tube structures 268, 270, 272, 273, 274 that act as workinglumens for the accessory device as discussed above. The tube structures268, 270, 272, 273, 274 can be secured to either or both layers 232, 234such that they remain stationary within the wall structure 226. In anadditional variation, the intermediate space 233 can be selectivelypressurized with a fluid to increase or decrease a stiffness of the wallstructure 226. In such a variation, the wall structure 226 is designedsuch that fluid can flow between adjacent tubular structures.Alternatively, the wall structure 226 can have separate areas in theintermediate space 233 that can be individually pressurized. As notedherein, the internal passage 273 of the accessory device can also beselectively pressurized.

FIG. 3D illustrates a condition where the wall structure 226 is allowedto collapse or otherwise form an irregular shape about the endoscope 90.This irregular shape assists in advancing the accessory device throughnarrow passages or other anatomy that would be difficult to navigate.When the wall structure 226 assumes an irregular shape, one or more ofthe tubular structures 268, 270, 272, 273, 274 will provide sufficientcolumn strength to advance the wall structure 226 over the endoscope/tothe region of interest.

FIGS. 4A and 4B illustrate respective side and top views of anothervariation of a hub 260 without the wall structure, connectors oradaptors. As shown, the hub 260 includes any number of openings 267, 269for accessing the various lumens and passages within the wall structureas discussed above. In the variation shown in FIGS. 4A and 4B theopenings 267, 279 are aligned along the hub 260.

FIGS. 5A and 5B illustrates an endoscopic accessory device 220 joinedinto a tubular structure but prior to securing the tip 238 about anendoscope. FIG. 5A illustrates a belt 240 of the tip 238 as wrappingtowards the opening slit 239. As noted herein, a distance from theshoulder 241 of the tip 238 to a position of the opening 239 limits thediameter of the tip 238 to prevent the distal opening to be too large orover-tightening on an endoscope, while the adhesive regions 241 allowsfor maintaining the tip 238 in a closed configuration. In variationsshown in FIGS. 5A and 5B, the proximal edge 235 of the tip 238 overlapsthe seam structure 228/230. In both FIGS. 5A and 5B the exterior balloon236 is shown in an uninflated state. However, in FIG. 5B the tip 238 istransparent to illustrate the seam structures 228 230 as joinedtogether. In addition, the inner flap 248 overlaps the seam structures228 230 to assist in reducing friction of the endoscope over the seamand creating a fluid seal at the seam. For purposes of illustration, theFigures show the inner layer 232 and outer layer 234 as directlyadjacent to each other. However, as noted above, the layers 232 234 canbe spaced to accommodate lumens, passages, and/or tubing of filled withfluid as discussed above.

FIG. 5C shows a state where a belt 240 of the tip 238 is insertedthrough the opening slit 239 and the adhesive removeable cover isremoved from the adhesive region to secure the overlapping region of thetip 238. The belt 240 of the tip 238 is then wrapped around and can besecured to the tip 238 as shown in FIG. 1 .

FIGS. 6A and 6B illustrate a variation of an endoscopic accessory device220 when positioned within a colon 2. As shown, a catheter balloon 224and endoscope 90 extend from a tip 238 of the device 220. When thedistal balloon 222 of the catheter 224 is expanded, the region betweenthe proximal balloon 236 and the distal balloon 222 on the catheterballoon 224 establishes an endoluminal compartment for improvedexamination of the colon 2 (or other body region) for examination ofpolyps and adenoma detection. However, the device 220 can also be usedin situations where the colon is insufficiently prepared (poor prep) ornot prepared (no prep) for a colonoscopy such that waste 6 remains inthe colon 2.

FIG. 6A illustrates the device 220 in a configuration where the proximalballoon 236 is inflated and fluid is delivered into the colon 2. Thedevice 220 can optionally include fluid ports 216 that deliver fluids atlow or high pressure to aid in cleaning the colon 2. Alternatively, orin combination, fluid can be delivered to the colon 2 not using theaccessory device 220. FIG. 6A also shows the distal balloon 222 of thecatheter balloon 224 expanded. Optional variations include cleaning ofthe colon 2 without inflating the balloon 222 on the catheter 224.Moreover, additional variations can include a device 220 where someports 216 are used as vacuum ports to remove fluid.

FIG. 6B illustrates movement of the accessory device 220 and inflatedballoons 236 in a rearward direction such that the balloons 236 performa squeegee function to propel both fluid and fecal matter 6 away fromthe region to be examined (i.e., the region between balloons 222 236)while wiping the intestinal wall of fluid secretion and other residualmatter.

FIGS. 7A to 7G illustrate another variation of an endoscopic accessorydevice 220 for performing a right colonic enema.

FIG. 7A illustrates the right colon 2 where an endoscope 90 can bepositioned without the accessory device 220. Once positioned theaccessory device 220 can be fastened about the endoscope 90 and advancedinto position. Once in position the proximal balloon 236 is expanded.

FIG. 7B illustrates the accessory device 220 and endoscope 90 remainingin position as a balloon catheter 224 is advanced distally to the device220. FIG. 7C shows optional removal of the endoscope from the device220. The device can be coupled to a fluid source such as a bag 20containing a fluid 8. The bag 20 is coupled to a hub (not shown) of theaccessory device 220 via a fluid line 24. FIG. 7 c illustrates the bag20 in an elevated position such that, as shown in FIG. 7D, gravitycauses the fluid 8 to pass through the accessory device 220 and into theright colon 2.

Next, after the fluid 8 is within the colon 2 for a sufficient time, thebag can then be placed lower than the patient, as shown in FIG. 7E sothat gravity causes the fluid and waste to flow back into the same bag20. It is noted that the balloon 222 of the balloon catheter 224 canremain inflated or uninflated.

As an alternative variation and as shown in FIG. 7F, once the fluiddrains by the force of gravity, the balloon 222 can be inflated and theballoon catheter 224 is pulled backward inside the colon 2 and retractedwithin the device 220 to clear residual fluid 8 from the colon. It isnoted that the device 220 can remain in place. FIG. 7G illustrates theballoon 222 and catheter 224 pulled towards the device 220 such thatadditional fluid 8 is driven into the device 220 and into the bag 20 viathe line 24. The line 24 can then be disconnected from the device 220and the bag 20 with the line 24 can then be discarded. The endoscope 9can then be reintroduced into the device 220 to the colon 2 inside theendoluminal compartment (not shown).

As for other details of the present invention, materials andmanufacturing techniques may be employed as within the level of thosewith skill in the relevant art. The same may hold true with respect tomethod-based aspects of the invention in terms of additional acts thatare commonly or logically employed. In addition, though the inventionhas been described in reference to several examples, optionallyincorporating various features, the invention is not to be limited tothat which is described or indicated as contemplated with respect toeach variation of the invention.

Various changes may be made to the invention described and equivalents(whether recited herein or not included for the sake of some brevity)may be substituted without departing from the true spirit and scope ofthe invention. Also, any optional feature of the inventive variationsmay be set forth and claimed independently, or in combination with anyone or more of the features described herein. Accordingly, the inventioncontemplates combinations of various aspects of the embodiments orcombinations of the embodiments themselves, where possible. Reference toa singular item, includes the possibility that there are plural of thesame items present. More specifically, as used herein and in theappended claims, the singular forms “a,” “and,” “said,” and “the”include plural references unless the context clearly dictates otherwise.

It is important to note that where possible, aspects of the variousdescribed embodiments, or the embodiments themselves can be combined.Where such combinations are intended to be within the scope of thisdisclosure.

The scope of the present invention, therefore, is not intended to belimited to the exemplary aspects shown and described herein. Rather, thescope and spirit of present invention is embodied by the appendedclaims.

I claim:
 1. An endoscopic accessory device, for use with an endoscope,the endoscopic accessory device comprising: a wall structure having aproximal portion spaced in a lengthwise direction from a distal portionalong an axis, the wall structure having a first edge and a second edgeextending parallel to the axis in the lengthwise direction from aproximal end of the proximal portion to a distal end of the distalportion and separated by a wall structure width, wherein the wallstructure includes an interior surface, an exterior surface, and anintermediate space therebetween; a tip material at located at the distalportion and having a tip length extending distally beyond the distalend, the tip material having a tip width greater than the wall structurewidth; a first seam structure extending along the first edge and asecond seam structure extending along the second edge; a proximalballoon located on the exterior surface at the distal portion; an innerballoon located on the interior surface and proximally spaced from thedistal end; and a hub portion at the proximal portion of the wallstructure and on the exterior surface; wherein in a pre-deploymentconfiguration the proximal balloon and the inner balloon are uninflated,and the wall structure is sufficiently flexible to assume a flat profileacross the wall structure width; wherein the first seam structure can bereleasably joined to the second seam structure to form a fluid tightseal therebetween such that the wall structure can form a closedovertube profile about the endoscope; wherein in the closed overtubeprofile the tip width of the tip material permits the tip material tocircumferentially overlap the distal end.
 2. The endoscopic accessorydevice of claim 1, wherein the hub portion comprises at least a proximalballoon port fluidly coupled to the proximal balloon by a proximalballoon lumen, an inner balloon port fluidly coupled to the innerballoon by an inner balloon lumen, and an instrument port fluidlycoupled to an instrument lumen.
 3. The endoscopic accessory device ofclaim 2, further comprising an instrument lumen opening on the interiorsurface distal to the inner balloon where there is an inner lockingmechanism at the instrument port on the hub portion.
 4. The endoscopicaccessory device of claim 1, where the interior surface includes aflange portion extending over the first seam structure such that in theclosed overtube profile the flange portion covers the first seamstructure and the second seam structure when joined together.
 5. Theendoscopic accessory device of claim 1, where there is at least oneinner balloon where a width of the inner balloon is equal or greaterthan the wall structure width such that the inner balloon creates acircumferential fluid tight seal over the endoscope within the interiorsurface when in the closed overtube profile.
 6. The endoscopic accessorydevice of claim 1, where the interior surface comprises of at least oneinterior sheet of material and the exterior surface comprises of atleast one exterior sheet of material.
 7. The endoscopic accessory deviceof claim 1, further comprising a catheter lumen extending from theproximal portion to the distal portion and having a port on the hubportion and a catheter opening on the interior surface distal to theinner balloon where there is an inner locking mechanism at a catheterport on the hub portion.
 8. The endoscopic accessory device of claim 7,further comprising a balloon catheter having a distal balloon andslidably moveable through the catheter lumen, where the hub portionincludes a catheter port fluidly coupled to the catheter lumen and aproximal end of the balloon catheter is slidably positioned in thecatheter port.
 9. The endoscopic accessory device of claim 8, whereinthe catheter lumen is configured to store the distal balloon insidewhile deflated.
 10. The endoscopic accessory device of claim 1, where aflexibility of the distal portion is greater than a flexibility of theproximal portion.
 11. The endoscopic accessory device of claim 10, wherea material of the of the tip material is different from a material ofthe distal portion.
 12. The endoscopic accessory device of claim 1,further comprising at least one adhesive region on the tip material,such that the at least one adhesive region permits securing a firstportion of the tip material to a second portion of the tip material in aconical or tubular shape.
 13. The endoscopic accessory device of claim1, wherein the tip material comprises a slit and a stop surface, suchthat when an end of the tip material is inserted into the slit, the tipmaterial forms a conical or tubular shape, wherein the stop surfacelimits advancement of the end of the tip material into the slit to limitan inner diameter of the tip material.
 14. The endoscopic accessorydevice of claim 1, wherein when in the closed overtube profile a portionof the tip material overlaps a portion of the first seam structure andthe second seam structure.
 15. The endoscopic accessory device of claim1, wherein the first seam structure comprises a first alignment surfaceadjacent to the tip material, and where the second seam structurecomprises a second alignment surface adjacent to the tip material,wherein the first alignment surface nests with the second alignmentsurface to align the first seam structure to the second seam structure.16. The endoscopic accessory device of claim 1, wherein when in theclosed overtube profile the tip material is configured to form a conicalshape at an end of the closed overtube profile.
 17. The endoscopicaccessory device of claim 1, wherein in the closed overtube profile,when expanded the proximal balloon is asymmetrical about the wallstructure.
 18. The endoscopic accessory device of claim 1, furthercomprising at least one fluid lumen connecting a fluid port on theexterior surface of the wall structure to the hub portion.
 19. Theendoscopic accessory device of claim 1, further comprising at least onefluid lumen connecting a fluid port on the interior surface of the wallstructure to the hub portion.
 20. The endoscopic accessory device ofclaim 1, further comprising at least one instrument lumen extending fromthe proximal portion to the distal portion and having a port on the hubportion and an opening on the interior surface distal to the innerballoon, where the hub portion includes instrument port that is fluidlycoupled to the at least one instrument lumen and an endoscopicinstrument is slidably positioned in the instrument port where there isan inner locking mechanism at the instrument port on the hub portion.21. The endoscopic accessory device of claim 1, where there is a barrieron the interior surface of the wall structure such that the barriercreates a circumferential fluid seal on the interior surface when in theclosed overtube profile.
 22. The endoscopic accessory device of claim 1,further comprising at least one passageway in fluid connection through aport on the hub portion to the distal portion.
 23. The endoscopicaccessory device of claim 1, further comprising of hydrophilic orhydrophobic coating on the interior surface and/or the exterior surfaceof the wall structure as well as catheter and instrument lumen.
 24. Theendoscopic accessory device of claim 1, wherein the hub portion includesat least one port to permit delivery of a fluid into the intermediatespace to adjust a flexibility of the wall structure.
 25. A method ofpreparing a colon for examination, the method comprising: advancing anendoscope within the colon; advancing an endoscopic accessory deviceover the endoscope, the endoscopic accessory device including a firstballoon adjacent to a distal opening; expanding the first balloonagainst a wall of the colon; positioning a balloon catheter through thedistal opening such that a second balloon on the balloon catheter isspaced from the distal opening; delivering a fluid through theendoscopic accessory to the colon; expanding the second balloon againstthe wall of the colon; and withdrawing the first balloon and the secondballoon while engaged against the wall of the colon to prepare the colonfor examination.
 26. A method of preparing a colon for examination, themethod comprising: advancing an endoscope within the colon; advancing anendoscopic accessory device over the endoscope, the endoscopic accessorydevice including a first balloon adjacent to a distal opening; expandingthe first balloon against a wall of the colon; positioning a ballooncatheter through the distal opening such that a second balloon on theballoon catheter is spaced from the distal opening; delivering a fluidthrough the endoscopic accessory to the colon by positioning a fluidreservoir at above the endoscopic accessory such that gravity causes thefluid to flow into the colon; draining the fluid from the colon bylowering the fluid reservoir below the endoscopic accessory such thatgravity causes a portion of the fluid to drain into the fluid reservoir;and expanding the second balloon against the wall of the colon andwithdrawing the second balloon towards the distal end to cause the fluidto enter the distal opening and to prepare the colon for examination.